History of Medicine

History of medicine shows how societies have changed in their approach to illness and disease from ancient times to the present.

History of Medicine – Learning Objectives for Physicians

At the end of the learning session, the student (medical student or physician) must be able to:

Realize how medicine is being practiced from antiquity to present by both practitioners (formal and informal) and patients.
Realize the success and failure and the advantages and disadvantages of the medical practices from antiquity to present.
Realize the current trends of medical practices and health care systems globally, ASEAN (Association of Southeast Asian Nations) and in the Philippines.
Health Equity
- Discuss the concept of health equity / inequity; types; causes; and extent globally, in ASEAN and in the Philippines.
- Formulate a proposal on how to control health inequity in the Philippines.
Derive learning from history of medicine to be used in the formation of a basic-generalist physician and practice of medicine.
Formulate a personal approach in the practice of medicine in terms of proper physician mindset vis-a-vis patient mindset.

Some topics / issues to touch on:

Illness – death

Limit to life span

Limit of Physicians: Cure sometimes, relieve often, care always

Medical Management with and without scientific basis for recovery

Physician mindset

a believer or a doubter, a maximalist or a minimalist, naturalism or technology

Patient mindset

a believer or a doubter, a maximalist or a minimalist, naturalism or technology

Cost of treatment - increasing

Commercialization / Medicalization

Health equity / inequity - How to control

Universal health care

PhilHealth

Practice or approach - physician's mindset vs patient's mindset

Hippocrates of Kos (c. 460 – c. 370 BCE), considered the "father of Western medicine."

HIPPOCRATIC OATH, MODERN VERSION

I swear to fulfill, to the best of my ability and judgment, this covenant:

I will respect the hard-won scientific gains of those physicians in whose steps I walk, and gladly share such knowledge as is mine with those who are to follow.

I will apply, for the benefit of the sick, all measures which are required, avoiding those twin traps of overtreatment and therapeutic nihilism.

I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon's knife or the chemist's drug.

I will not be ashamed to say "I know not," nor will I fail to call in my colleagues when the skills of another are needed for a patient's recovery.

I will respect the privacy of my patients, for their problems are not disclosed to me that the world may know. Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God.

I will remember that I do not treat a fever chart, a cancerous growth, but a sick human being, whose illness may affect the person's family and economic stability. My responsibility includes these related problems, if I am to care adequately for the sick.

I will prevent disease whenever I can, for prevention is preferable to cure.

I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.

If I do not violate this oath, may I enjoy life and art, respected while I live and remembered with affection thereafter. May I always act so as to preserve the finest traditions of my calling and may I long experience the joy of healing those who seek my help.

Written in 1964 by Louis Lasagna, Academic Dean of the School of Medicine at Tufts University, and used in many medical schools today.

Medicine is not an exact science! Medicine is a science of uncertainty and an art of probability!

History of medicine as it applies in the formation of a basic-generalist physician and in the practice of medicine

History of medicine is essentially history of mankind, when they started coming out on earth, when they were born, how they were born, when and how they grow up and mature, how they die, how they get sick, how they recover from sickness, and how they are treated (medical management) and the outcomes.

Stages of life cycle of mankind

When humans started coming out on earth

It is estimated that 100,000 years or even million years ago Before Christ that man started inhabiting the earth. The modern man is called Homo sapiens. Its closest relatives are the chimpanzees. Homo sapiens is defined by Dictionary.com as the species of bipedal primates to which modern humans belong, characterized by a brain capacity averaging 1400 cc (85 cubic in.) and by dependence upon language and the creation and utilization of complex tools.

World population

At the dawn of agriculture, about 8000 B.C., the population of the world was approximately 5 million. Over the 8,000-year period up to 1 A.D. it grew to 200 million (some estimate 300 million or even 600, suggesting how imprecise population estimates of early historical periods can be), with a growth rate of under 0.05% per year.

http://www.worldometers.info/world-population

Insights

The world population keeps on growing, from 1804 to 7.5 billion in April 2017.

These are potential patients. So the medical profession will be maintained. Basic-generalist physicians, specialists and subspecialists are still needed.

Despite wars in the past, before and during the World Wars, this is not enough to decrease the number in the world population.

Despite pandemics and epidemics in the past, this is not enough yet to decrease the number in the world population.

Some countries have controlled the number in their population through population control either formally (legislated) or informally (personal choice). However, the number of countries with population control measures is not enough yet to decrease the number in the world population.

Limited lifespan of human beings

The longest officially recorded lifespan in the world was 122 years (122 years and 164 days) (1875–1997) in a female, Jeanne Calment, of France. In the male, the longest officially recorded lifespan in the world was 116 years (116 years and 54 days) (1897-2013) was Kiroeman Kimura of Japan.

Worldwide, the average life expectancy at birth was 71.0 years (68.5 years for males and 73.5 years for females) over the period 2010–2013 according to United Nations World Population Prospects 2012 Revision.

Insights

No human beings live forever. They eventually die. The average life expectancy at birth is 71.0 years (2013).

Human beings should take cognizant of this limitation in life, accept this reality and prepare for the eventuality. They should at the moment target at least 70 years of socially and economic productive life. If they die before 70, they will be classified as dying a premature death by the World Health Organization. After 70 years, everything is a bonus.

The medical profession should take cognizant of this limitation in life and consider this in the management of patients. Physicians may have to stop heroic measures in the management of patients with high probability of incurability of disease.

The physicians should assist their patients in living a socially and economic productive life at least up to 70 years old.

World Health Organization has used 70 years old as the cut-off age for considering premature death. The target is to have people live up to at least 70 years old.

Mankind and different cultures

There are about 195 countries in the world at present. These different countries represent different cultures.

Insights

Different cultures will affect the mindset of people including those of the physicians in health promotion and restoration and in the practice of medicine.

Diseases afflicting mankind

Communicable diseases

Non-communicable diseases

Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another. Zoonotic diseases are infectious diseases of animals that can cause disease when transmitted to humans.

Communicable diseases continue to be among the most serious public health problems in the Western Pacific Region. The challenges arise from ancient diseases such as malaria, measles and leprosy to more recent infections, including HIV, and re-emerging diseases such as dengue. Communicable diseases not only cause illness and death, but also can disrupt the socioeconomic progress of nations.

The Western Pacific Region bears a significant proportion of the global burden of many communicable diseases, including cholera, hepatitis B and tuberculosis. Some regional problems, such as resistance to the antimalarial drug artemisinin and the burden of multidrug-resistant tuberculosis, also pose significant global threats.

http://www.wpro.who.int/about/administration_structure/dcc/en/

Noncommunicable diseases

WHO Fact sheet

Updated April 2017

Key facts

Noncommunicable diseases (NCDs) kill 40 million people each year, equivalent to 70% of all deaths globally.
Each year, 17 million people die from a NCD before the age of 70; 87% of these "premature" deaths occur in low- and middle-income countries.
Cardiovascular diseases account for most NCD deaths, or 17.7 million people annually, followed by cancers (8.8 million), respiratory diseases (3.9million), and diabetes (1.6 million).
These 4 groups of diseases account for 81% of all NCD deaths.
Tobacco use, physical inactivity, the harmful use of alcohol and unhealthy diets all increase the risk of dying from a NCD.
Detection, screening and treatment of NCDs, as well as palliative care, are key components of the response to NCDs.

http://www.who.int/mediacentre/factsheets/fs355/en/

Triple burden of disease (Philippines Health Agenda 2016-2022)

Communicable diseases ( HIV/AIDS, TB, Malaria, diseases for elimination, dengue, lepto, Ebola, Zika)

Non-communicable diseases including malnutrition ( cancer, diabetes, heart disease and their risk factors – obesity, smoking, diet, sedentary lifestyle, and malnutrition)

Diseases of Rapid Urbanization and Industrialization (injuries, substance abuse, mental Illness, pandemics, travel Medicine, health consequences of climate change / disaster

Top 10 causes of mortality and morbidity

WHO and countries usually keep track of the top 10 causes of mortality and morbidity. These data can be used for action planning purposes.

Leading causes of global deaths

2015

1. Ischaemic Heart Disease

2. Stroke

3. Lower Respiratory Infections

4. Chronic Obstructive Pulmonary Disease

5. Trachea, Bronchus, Lung Cancers

6. Diabetes Mellitus

7. Alzheimers Diseases and other Dementias

8. Diarrhea

9. Tuberculosis

10. Road Injury

http://www.who.int/mediacentre/factsheets/fs310/en

Insight

There will always be top 10 causes of mortality and morbidity.

The arrangement in terms of frequency of each cause of mortality and morbidity will vary from year to year from country to country.

What is more important to consider is the magnitude of each mortality and morbidity and then to control to an acceptable level.

History of Medicine and Medical Practices

Studying and analyzing the history of medicine is essentially studying and analyzing the history of mankind which in turn is also studying and analyzing the history of the medical treatment of human beings when they sick or the practice of medicine by formal and informal practitioners and by patients from ancient to present times.

Medical treatment means the management and care of a patient to combat disease or disorder.

The practice of medicine involves diagnosis, treatment, or correction of human conditions, ailments, diseases, injuries, or infirmities whether physical or mental, by any means, methods, devices, or instruments.

As mentioned, in the history of medicine, medical treatment can be done by formal and informal practitioners and by patients themselves. There are myriads of ways of medical treatment and medical practice from antiquity to present.

They can fall under two general categories: faith healing and non-faith healing. Faith healing is the method of treating diseases just by prayer and exercise of faith in God. The non-faith healing medical treatment or practices include the following subtypes, namely, 1) folk medicine or traditional medicine; 2) mainstream or conventional medicine; and 3) alternative and complementary and integrative medicine.

Folk medicine is the treatment outside mainstream medicine by remedies and measures based on experience and knowledge handed down from generation to generation. Thus, the other term in traditional medicine. It is traditional medicine as practiced by nonprofessional healers or embodied in local custom or lore, generally involving the use of natural and especially herbal remedies.

Mainstream medicine is the conventional healthcare based on the “Western model” of evidence-based practice for diagnosing and treating disease. The other term is conventional medicine. Mainstream medicine assumes that all physiologic and pathological phenomenon can be explained in concrete terms. Mainstream medicine implies that the other forms of medicine present are outside the mainstream such as the alternative and folklore medicines.

Alternative medicine and complementary medicine are groups of medical practices that are considered to be outside the realm of conventional medicine. The folk medicine strictly speaking can be considered as a non-mainstream medicine but is a different entity from alternative and complementary medicine by virtue of its definition – traditional medicine as practiced by nonprofessional healers or embodied in local custom or lore. If the non-mainstream practice is used in place of the conventional medicine, then it is considered an alternative medicine. If the non-mainstream practice is used together with conventional medicine, then it is considered as a complementary medicine. When the complementary medicine is integrated into the conventional medicine, then it is considered as an integrative medicine.

As medicine evolves, some practices that were considered non-mainstream such as folk, complementary and alternative medicines may become a part of conventional medicine and will no longer be considered non-mainstream or alternative medicine.

Insights:

For faith-healing:

All patients with a remediable medical condition should do self-treatment or seek assistance from physicians or medical practitioners rather than just purely rely on prayer and an exercise of faith. They can complement the self-treatment and treatment by physicians or medical practitioners with prayers and exercise of faith though (praying and hoping that they will be successfully healed).

For the non-faith healing medical practices:

All patients should give priority to mainstream medicine over non-mainstream medicine particularly those with data showing effectiveness for the former. If there are data showing effectiveness for the non-mainstream medicine, go ahead.

The non-mainstream medicine may be use as a complement to mainstream medicine as long as they can be shown to produce better results when combined.

Faith Healing - a method of treating diseases just by prayer and exercise of faith in God.

The use of faith healing, or the laying-on of the hands to heal human illness has been practiced in ancient times up to now. Evidence for its use in ancient Egypt is found in the Ebers Papyrus dated at around 1552 BC. This document describes the use of the laying-on of the hands for medical treatment. Centuries before the birth of Jesus Christ, the Greeks used therapeutic touch therapy in their Asklepian temples for healing the sick.

Faith healing may occur in relation not only to specially gifted persons, but also to specific places. Studies conducted by the medical office of the Catholic church have documented 36 "miracles" at Lourdes in which a person was cured of documented disease. Since 1800 a number of Protestant faith-healing groups have appeared, including that of John Alexander Dowie, the Emmanuel movement, and the Peculiar People (“chosen people”), a name applied to numerous Protestant dissenting sects such as the Plumstead peculiars. This group, founded in London in 1838 by John Banyard, refused medical treatment as an article of faith.

There are a host of unorthodox religious groups in America—Seventh-Day Adventists, Christian Scientists, Mormons, Jehovah’s, and Pentecostals—who have all had a strong interest in faith healing, including using laying-on of hands and healing touch. Ellen Gould White (1827-1911) and Mary Baker Eddy (1821-1910) founded their religious group around healing experiences. Other women healers, including Maria B.Woodworth-Etter and Aimee Semple McPherson, were instrumental in forming groups of Pentecostals at the turn of the century.

Based on healing experiences, Mary Caroline (“Myrtle”) Fillmore (1845-1931) founded the Unity Church. As a spiritualist, Fillmore and others communed with the departed by passing hands over the body to unblock vital fluid. These healers are the direct forerunners of New Age trance channeling. Kathryn Kuhlman is yet another faith healer who held miracle services from the early 1950s until her death in 1976. Kulhman had a strong following across the nation and even held her famous miracle healing services in Carnegie Hall for 20 years, filling the great auditorium to capacity every time.

https://www.sharecare.com/health/faith-healing/the-history-of-faith-healing

Miraculous recoveries have been attributed to a myriad of techniques commonly lumped together as "faith healing in the name of a greater power.” But what is this spiritual side of healing touch--a side that some claim as miraculous, yet that is controversial among many? Faith healing is a process through which someone is healed, whether physically, mentally, or spiritually, by what is said to be the direct intervention of divine or super natural power. Faith healing is unlike conventional medicine, which treats disease with specific therapies developed through observation and research, and from alternative medicine, which fights illness with remedies gathered from ancient or traditional lore.

While most Western scientists will tell you faith healing is no substitute for medication or surgery, the belief that prayer, faith or divine intervention of a healer can actually cure illness has been known since the beginning of recorded history. The efficacy of faith healing to effect cure of disease has not been scientifically proved, but the popularity and subjective potency of such interventions is indisputable.

https://www.sharecare.com/health/faith-healing/what-is-faith-healing

The gospels contain many examples of Jesus (and even the apostles) healing the sick and lame. However, the healings of Jesus were given as a sign of the legitimacy of His claim of Messiahship, since the Old Testament said that the Messiah would heal the blind and the deaf. Jesus recognized the important roles of physicians in His time. Jesus said, "It is not those who are healthy who need a physician, but those who are sick."

Relying on faith healing:

http://www.religioustolerance.org/medical3.htm (lifted on April 13, 2017)

We have been unable to find references to any double-blind controlled studies which compare the effectiveness of faith healing in place of regular medical procedures. We located a few statements and surveys:

Jehovah's Witnesses: In 1997-FEB, the writer of a book review in the American Medical Association's journal estimated that the Jehovah's Witnesses' belief about blood transfusions has "led thousands to die needlessly." 1The Watchtower periodical Awake once showed pictures of Jehovah's Witnesses children who followed the churches ban on blood transfusions and died. 2 It is, of course, unknown how many would still have died even if they had transfusion(s).

Christian Science: William F. Simpson, an assistant professor of mathematics and computer science at Emporia State University conducted an exploratory study into the effectiveness of Christian Science healing. He compared alumni records from a Christian Science school (Principia College in Elsah, IL) with those from the secular University of Kansas in Lawrence, KS. One would expect that if Christian Science healing is as effective as conventional medicine, then the graduates of Principia College would live longer than those from Kansas. This is because the Church forbids the use of alcohol and tobacco. But the results were in the opposite direction. The death rates among Principia graduates from 1934 to 1948 were significantly higher than those of the University of Kansas graduates. (26.2 vs. 20.9% for men; 11.3 vs. 9.9% for women).

A more realistic study was made later, comparing the mortality of Christian Scientists and Seventh-day Adventists. Both denominations abstain from alcohol and tobacco. Even greater differences were found in the second test, again with Christian Scientists having higher mortality rates. 3,4 This type of study is fairly crude; its results should not be treated as precise or conclusive. Graduates at different universities may have, on average, been raised under different conditions, or might enter professions of differing danger levels, they might have entered military service at different rates, etc. However, the studies appear to indicate that Christian Science healing is significantly less effective than standard medicine. That is, choosing Christian Science prayer in place of conventional medicine causes additional, preventable deaths.

U.S. death toll among infants and children: In 1998-APR, Dr. Seth Asser, a critical-care pediatrician at Methodist Children's Hospital in San Antonio, and Rita Swan, head of the advocacy group Children's Healthcare is a Legal Duty (CHILD) authored a paper in the professional journal Pediatrics. Asser studied 172 reported deaths of infants and children between 1975 and 1995. Deaths were found in 34 states among members of 23 religious groups. They belonged to families of Christian Scientist, Faith Tabernacle, Faith Assembly and several other religious groups that practice faith healing. He compared the cause of death with the expected survival rates if the children had received routine medical care. They found:

140 children would have had a 90% chance of surviving if they had been treated medically.

18 children would have had a 50 to 90% chance of surviving

11 children would have received some benefits from medical care

3 would not have been helped from medical care

The 172 deaths are presumably some unknown fraction of the total deaths among children whose parents used faith healing in place of medical treatment.

Also unknown are the numbers of children who died after having received medical treatment who would have been saved by faith healing. As structured, the study only analyzes one side of the story.

Many of the conditions and diseases that killed the 172 children were "ordinary ailments seen and treated routinely" e.g. appendicitis, labor complications, dehydration, antibiotic-sensitive bacterial infections and vaccine-preventable disorders. They cited cases in which:

A 2 year old child choked on a piece of banana and died an hour later, while her parents frantically gathered other church members into a circle to pray.

Children with an infection who would have been saved with a single injection of penicillin.

Babies who would have lived if they received oxygen.

Five mothers died from relatively common and treatable complications during labor.

Several children died after long periods of terribly painful suffering. 5,6

The article concludes:

"The children of members of faith-healing sects deserve the same protections under the law as other children have. We believe that the repeal of exemption laws is a necessary step toward assuring such protection...before hundreds more children suffer needlessly and die prematurely."

Robert Gilbert of the Christian Science Committee on Publication said the study was biased and misleading:

"The assumption here is that you can judge a religion only by its failures, when the fact is we have quite a good record in the 130-plus years of Christian Science healing. And it's a tragedy whenever a child dies."

Unfortunately, the denomination does not release its data to the public; the effectiveness of its healing methods remains unknown.

In this day and age, should people always seek medical treatment from certified physicians or just pray or do both?

If a patient is healed of an incurable disease through prayer and exercise of faith in God, it is considered a miracle. Miraculous healing may still occur nowadays but it is very rare.

The non-faith healing medical treatment or practice includes the following subtypes, namely, 1) folk medicine or traditional medicine; 2) mainstream or coventional and modern medicine; and 3) alternative or complementary or integrative medicine.

Folk medicine - traditional medicine as practiced nonprofessionally especially by people isolated from modern medical services and usually involving the use of plant-derived remedies on an empirical basis

https://www.merriam-webster.com/dictionary/folk%20medicine

treatment of disease or injury based on tradition, especially on oral tradition, rather than on modern scientific practice, and often utilizing indigenous plants as remedies.

health practices arising from superstition, cultural traditions, or empirical use of native remedies, especially food substances.

If a non-mainstream practice is used together with conventional medicine, it’s considered “complementary.”

If a non-mainstream practice is used in place of conventional medicine, it’s considered “alternative.”

True alternative medicine is uncommon. Most people who use non-mainstream approaches use them along with conventional treatments.

“complementary health approaches” when we discuss practices and products of non-mainstream origin.

“integrative health” when we talk about incorporating complementary approaches into mainstream health care.

Most complementary health approaches fall into one of two subgroups—natural products or mind and body practices.

Alternative medicine is a term that describes medical treatments that are used instead of traditional (mainstream) therapies. Some people also refer to it as “integrative,” or“complementary” medicine.

About 40% of adults in the United States say they use some form of alternative medicine.

The term Alternative Medicine means any form of medicine that is outside the mainstream of western medicine or conventional medicine as practiced a majority of doctors today. This term is loosely used to over all forms of medicine except allopathy. In 1973, the Medical Faculty of the University of Rome convened the first World Congress of Alternative Medicines and the provisional program contained no less than 135 therapies.

Alternative medicine exists in all cultures to some degree and terms such as traditional medicine, indigenous medicine or folk medicine etc. are used to describe such practices. These medicines date back hundred or even thousands of years depending on the country and culture concerned.

There are more than 100 systems of alternative medicines still in practice all over the world. Every country, region or area has its own traditional system of health and medical cares such as for the Chinese it is acupuncture, for the French, magnetic healing; for the Germans, Heilpraxis; for the English, Herbalism; for India, Ayurveda with Siddha being widely practice in the southern part of the country; for Japan, Shiatsu etc.

The most popular forms of alternative medicine are Ayurveda, Homeopathy, Naturopathy, Yoga, Acupuncture, Acupressure, Magneto therapy, Shiatsu, Herbalism, Meditation, Aromatherapy, Bach Flower Remedies, Chromo therapy, Diet therapy, Hydropathy and Reiki.

http://altmedworld.net/alternative.htm

What is Integrative Medicine?

Integrative medicine is a holistic medical discipline which takes into account the lifestyle habits of a patient. The physician works to treat the whole person rather than just the disease. The mind, body, and soul of a patient are taken into consideration to promote healing and well-being.

Integrative medicine uses a combination of modern healthcare practices to diagnose and treat a patient. Treatments may include such modalities as acupuncture, yoga, or massage. This medical practice also focuses on the nutritional and exercise habits of the patient to curb factors related to obesity and diabetes. Integrative medicine physicians believe poor lifestyle choices are the root cause of many modern chronic diseases.

What is Functional Medicine?

Functional medicine embraces much of the philosophy of Integrative medicine as described above but also employs a systems-oriented medical approach that works to identify and understand the underlying or root causes of a disease. This discipline takes into account the personalization of healthcare, as each patient care plan is distinct and unique. The relationship between patient and practitioner effectively becomes a partnership; every aspect of a patient’s medical history is reviewed in detail. Much like integrative medicine, functional medicine treats the individual rather than the disease.

Often, individual genetic and environmental research is conducted to obtain a deeper knowledge of the patient’s health status. Understanding the biochemical individuality of a patient can lead to the underlying causes of disease and furthermore, the prevention of additional health risks in the future. Functional Medicine has gained much popularity, even spurring the creation of the Institute for Functional Medicine. Personalized medicine is without a doubt, the future model of medical care.

Although integrative medicine and functional medicine have similarities, there is one important distinction. Both practices focus on supporting the patient as a whole person; however, functional medicine strives to determine the root cause of each and every disease, particularly chronic diseases such as autoimmune and cardiovascular diseases as well as, diabetes and obesity. Rather than simply making a diagnosis and then determining which drugs or surgery will best treat the condition, Functional Medicine practitioners dive deep into the patient's history and biochemistry and ask why this patient is ill. Functional medicine is highly personalized and often includes a detailed analysis of an individual’s genetic makeup.

Healthcare is undergoing drastic changes in the 21st century. In as few as five years we will look back and ask ourselves how we could have been practicing medicine so primitively. Those practitioners who embrace the Functional and Integrative Medicine paradigms will be at the forefront of healthcare in the 21st century.

Herbal Medicine

- - the art or practice of using herbs and herbal preparations to maintain health and to prevent, alleviate, or cure disease

- a plant or plant part or an extract or mixture of these used in herbal medicine

Who is using herbal medicine?

Nearly one-third of Americans use herbs. Unfortunately, a study in the New England Journal of Medicine found that nearly 70% of people taking herbal medicines (most of whom were well educated and had a higher-than-average income) were reluctant tell their doctors that they used complementary and alternative medicine (CAM).

What is the future of herbal medicine?

In some countries in Europe, unlike the U.S., herbs are classified as drugs and are regulated. The German Commission E, an expert medical panel, actively researches their safety and effectiveness.

While still not widely accepted, herbal medicine is being taught more in medical schools and pharmacy schools. More health care providers are learning about the positive and potentially negative effects of using herbal medicines to help treat health conditions. Some health care providers, including doctors and pharmacists, are trained in herbal medicine. They can help people create treatment plans that use herbs, conventional medications, and lifestyle changes to promote health.

http://www.umm.edu/health/medical/altmed/treatment/herbal-medicine

Health equity refers to the study and causes of differences in the quality of health and healthcare across different populations.^[1]

Health equity is different from health equality, as it refers only to the absence of disparities in controllable or remediable aspects of health. It is not possible to work towards complete equality in health, as there are some factors of health that are beyond human influence.^[2]

Inequity implies some kind of social injustice. Thus, if one population dies younger than another because of genetic differences, a non-remediable/controllable factor, we tend to say that there is a health inequality.

On the other hand, if a population has a lower life expectancy due to lack of access to medications, the situation would be classified as a health inequity.^[3]

These inequities may include differences in the "presence of disease, health outcomes, or access to health care"^[4] between populations with a different race, ethnicity, sexual orientation or socioeconomic status.^[5]

Health equity falls into two major categories: horizontal equity, the equal treatment of individuals or groups in the same circumstances; and vertical equity, the principle that individuals who are unequal should be treated differently according to their level of need.^[6]

Disparities in the quality of health across populations are well-documented globally in both developed and developing nations.

The importance of equitable access to healthcare has been cited as crucial to achieving many of the Sustainable Development Goals.

https://en.wikipedia.org/wiki/Health_equity

PhilHealth - Philippine National Health Insurance Agency

Goal - Health for all Filipinos through an insurance scheme

Trying to promote health equity

Case rate systems - trying to promote value-based health care services

Formulate a proposal on how to control health inequity in the Philippines.

Support the government, Department of Health and PhilHealth in their programs to control health inequity, especially the Sustainability Development Goals (2016-2030).

In your personal capacity as physicians, provide a Patient Assistance Program, particularly for the indigent patients (special professional fees - low or no-charge). Practice and promote value-based health care services. Support the case-rate systems of PhilHealth.

Refrain from commercialization of medical practice and avoid over-medicalization.

Medicalization

to view or treat as a medical concern, problem, or disorder

https://www.merriam-webster.com/dictionary/medicalize

To identify or categorize (a condition or behavior) as being a disorder requiring medical treatment or intervention

http://www.thefreedictionary.com/medicalization

Medicalization (or medicalisation) is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention, or treatment. Medicalization can be driven by new evidence or hypotheses about conditions; by changing social attitudes or economic considerations; or by the development of new medications or treatments.

https://en.wikipedia.org/wiki/Medicalization

Over-medicalization = Overdiagnosis, overtesting and overtreatment

OVERKILL

An avalanche of unnecessary medical care is harming patients physically and financially. What can we do about it?

http://www.newyorker.com/magazine/2015/05/11/overkill-atul-gawande

Commercialization of the Practice of Medicine

Somehow related to medicalization.

Managing patients primary for profit reason and not by what is really needed.

Self-serving investment practices of doctors

doctors have formed thousands of partnerships and joint ventures to which they refer patients for X-rays, laboratory services, outpatient surgery and medical equipment. These encourage the overuse of expensive medical services and procedures.